Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit

Freestone, Mark; Bull, Deborah; Brown, Roz; Boast, Neil; Blazey, Faye; Gilluley, Paul

doi:10.1186/s12888-015-0620-9

Cited by 33 publications

(44 citation statements)

References 18 publications

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“…Validation studies have shown good psychometric qualities (Flynn, O'Neill, McInerney, & Kennedy, 2011;Freestone et al, 2015;O'Dwyer et al, 2011) and indicated that the DUNDRUM-1 items can predict the level of therapeutic security needed (Flynn et al, 2011;Freestone et al, 2015) and LOS (Davoren et al, 2015) while the DUNDRUM-3 and DUNDRUM-4 can predict moves between levels of therapeutic security (Davoren et al, 2012) and discharge (Davoren et al, 2013).…”

Section: Dangerousness Understanding Recovery and Urgency Manual (Thmentioning

confidence: 99%

Patient characteristics related to length of stay in Dutch forensic psychiatric care

Eckert¹,

Schel²,

Kennedy

et al. 2017

The Journal of Forensic Psychiatry & Psychology

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Create an overview of characteristics of patients in long-term forensic psychiatric care (LFPC) with a higher length of stay (LOS) care compared to patients in regular forensic psychiatric care (RFPC) with a shorter LOS. Data were collected from 139 patient records. This study examined whether patients in LFPC differ from patients in RFPC on sociodemographic data, legal data and clinical data and whether those characteristics are able to predict LOS. Patients in LFPC were more often born in a Dutch Caribbean country, less often had a substance abuse disorder, were more often emotionally neglected during childhood, had a higher HCR-20 risk item score, a higher security needs score, a higher (less successful) recovery score, were more often recidivist and had absconded more often than RFPC patients. Certain characteristics were able to distinguish the longer LOS group which might be useful to establish sequel services and enhance treatment efficiency.

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Section: Dangerousness Understanding Recovery and Urgency Manual (Thmentioning

confidence: 99%

Patient characteristics related to length of stay in Dutch forensic psychiatric care

Eckert¹,

Schel²,

Kennedy

et al. 2017

The Journal of Forensic Psychiatry & Psychology

View full text Add to dashboard Cite

show abstract

“…In this study we found the scores on the DUNDRUM tool were closely aligned to the decisions of both the Broadmoor admission panel and the assessing clinicians. 9,10,15 This demonstrated the strong clinical relevance of the tool. The DUNDRUM tool is designed to support clinical decision-making regarding triaging admissions, but it does not replace clinical decision-making.…”

Section: Discussionmentioning

confidence: 73%

“…The DUNDRUM tools have been validated in forensic mental health hospital settings and prison settings in multiple jurisdictions and have excellent psychometric properties. 9,[14][15][16][17] The DUNDRUM-1 triage security scale has been shown to have good internal consistency (Cronbach's alpha 0.95 in a Dundrum sample validation and 0.77 in an international validation study) and good interrater reliability. 9,10,[15][16][17][18][19] Interrater reliability is better following training.…”

Section: Needs Assessment Tool For Secure Carementioning

confidence: 99%

Security needs among patients referred for high secure care in Broadmoor Hospital England

et al. 2020

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Background Security needs among patients referred to forensic mental health services have rarely been systematically studied. Aims To ascertain security needs among patients referred to a high secure hospital, Broadmoor High Secure Hospital, England. We also aimed to compare the security needs for those referred to mental illness services with those referred to personality disorder services in the hospital. Method A retrospective complete cohort study of all referrals to Broadmoor Hospital over a 2-year period was conducted. All referred patients (n = 204) were assessed for need for high secure care by two Broadmoor clinicians. The final decision on need for admission was taken by a multidisciplinary admission panel. Independent of the panel, researchers rated need for security using the DUNDRUM-1 triage security scale. Results Those admitted to Broadmoor Hospital had higher triage security scores than those declined (F = 4.209, d.f. = 1, P = 0.042). Referrals to the personality disorder pathway had higher security needs than those referred to the mental illness pathway high secure service (F = 6.9835, d.f. = 1, P = 0.0089). Overall security needs among referrals to Broadmoor were extremely high, both by comparison with previous needs identified in UK medium secure services and international medium and high secure services. Conclusions High secure patient cohorts represent a uniquely vulnerable group within mental health services, with extremely high security needs identified in this study. This has significant implications for services given the high levels of resources needed to provide therapeutically safe and secure care and treatment to this group.

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“…20 They rate the level of security a patient should be admitted to and the urgency of need for admission; has good psychometric properties and has been internationally validated. [21][22][23][24][25][26][27] The DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales were used in this study. These tools rate the successful completion of therapeutic programmes by the patients, and rate the patient's overall recovery in a holistic manner, respectively.…”

Section: Assessing Risk and Needsmentioning

confidence: 99%

Outcome measures of risk and recovery in Broadmoor High Secure Forensic Hospital: stratification of care pathways and moves to medium secure hospitals

et al. 2020

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Background Placements within high secure forensic hospitals consist of wards providing various different levels of relational security. They should form a coherent pathway through secure care, based on individual patient risks and needs. Moves to less secure wards within high secure forensic hospitals and moves on to lower secure hospital settings have rarely been systematically studied. Aims The aim of this study was to ascertain if placements within Broadmoor High Secure Hospital and moves from Broadmoor to medium secure hospitals corresponded to measures of violence risk, programme completion and recovery. Method A 13-month prospective cohort study was completed. Patients (n = 142) were rated at baseline for violence risk (Historical, Clinical and Risk – 20), therapeutic programme completion and recovery (DUNDRUM tool) and overall functioning (Global Assessment of Functioning). Placements on the care pathway and moves on to medium secure hospitals were observed. Results Placements on the care pathway within the high secure hospital were associated with dynamic violence risk (F = 16.324, P<0.001), therapeutic programme completion (F = 4.167, P = 0.003), recovery (F = 2.440, P = 0.050) with better scores on these measures being found in the rehabilitation wards and the poorest scores on the highest levels of dependency. Moves to medium secure hospitals were associated with better scores on dynamic risk of violence (F = 33.199, P<0.001), therapeutic programme completion (F = 9.237 P<0.001), recovery (F = 6.863, P = 0.001). Conclusions Placements within Broadmoor Hospital formed a coherent pathway through high secure care. Moves to less secure places were influenced by more than reduction in violence risk. Therapeutic programme completion and recovery in a broad sense were also important.

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Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit

Cited by 33 publications

References 18 publications

Patient characteristics related to length of stay in Dutch forensic psychiatric care

Patient characteristics related to length of stay in Dutch forensic psychiatric care

Security needs among patients referred for high secure care in Broadmoor Hospital England

Outcome measures of risk and recovery in Broadmoor High Secure Forensic Hospital: stratification of care pathways and moves to medium secure hospitals

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